Clients Viewpoints about the Quality of Services in the Premarital Counseling Classes in Tabriz Health Centers

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1 Clients Viewpoints about the Quality of Services in the Premarital Counseling Classes in Tabriz Health Centers Parvin Mohebbi, Padide Malekpour, Mahin Kamalifard 1, Shirin Barzanje Atri 1, Abdolrasoul Safaeiyan 2, Kamyab Alizadeh 3 Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran, 1 Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran, 2 Department of Vital Statistics, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran, 3 Department of Urology, Uro-Oncology Research Center (URoC), Tehran University of Medical Sciences, Tehran, Iran Correspondence to Parvin Mohebbi, Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran. E mail: pmohebbi@yahoo.com Date of Submission: Jan 28, 2013 Date of Acceptance: Nov 21, 2013 How to cite this article: Mohebbi P, Malekpour P, Kamalifard M, Atri SB, Safaeiyan A, Alizadeh K. Clients viewpoints about the quality of services in the premarital counseling classes in Tabriz health centers. Int J Prev Med 2014;5: ABSTRACT Background: Premarital counseling equips couples with information about all aspects of sexuality and the related health issues. This study was aimed to assess the quality of premarital counseling services in health care centers in Tabriz. Methods: A cross sectional study was conducted on 236 randomly selected women from premarital counseling centers in Tabriz was carried out and a self structured instrument including items on demographic characteristics, the quality of counseling condition and providers, family planning, genetic and thalassemia counseling and sexual health was used for data gathering. Results: The results showed that the viewpoint of clients about relationship with health care provider and condition of consultation was suitable in 75.8% and 85.2% of women, respectively. It was found that in 72.5%, 38.1% and 49.6% of clients the counseling areas were in moderate level respectively for counseling about importance of family planning, genetic counseling and thalassemia. It was indicated that 58.5% of participants expressed the sexual health aspect of the premarital classes as poor or completely poor. Conclusions: Our study results can provide suitable information for health policy providers to improve the quality of premarital counseling classes. In order to develop a relatively stable behavior in young couples, it is recommended that the quality of the classes would be overemphasized. Keywords: Counseling, family planning training, genetic, marriages, self concepts Brief Communication INTRODUCTION The premarital counseling programs for young couples are important issues of general health. In Iran, the ministry of health is responsible for the organization of these classes in all across the country. [1] Hence, compulsory premarital counseling programs for all couples wanting to marry became popular and the Population Action International in 2002 stated that Iran had implemented national governmental programs on young people s sexual and reproductive health. [2] 365

2 Premarital counseling as an educative, therapeutic and preventive approach [3] supports couples to deal with issues and challenges during their marriage including the family planning methods that enhances acceptance and continuous use of the contraceptive methods and improves the individual s satisfaction with them. It also includes information about genetic counseling, thalassemia and sexual health, the purpose of which is the enhancement of life and personal relations. The assessment of the quality of the classes in this study can help the health care provider and health policy makers to redesign the contents of training courses and perform programs based on the requirements for improvement of this process. Thus, this study aimed to evaluate the clients viewpoints about the quality of services in the premarital counseling classes in health care centers of Tabriz, Iran. METHODS A cross sectional study was carried out on women attending the premarital classes in two health care centers (Haftom e tir and Asadabadi) in Tabriz city, in The study protocol was approved by the ethics committee of Tabriz University of Medical Sciences and an informed consent was obtained from all participants. The inclusion criteria were females being at the first marriage and having at least primary literacy to complete the questionnaire. Subjects were selected by simple random sampling method in both health care centers. A total of 236 subjects was the calculated sample size and they were randomly selected during 3 months from classes in both centers. A self administered structured questionnaire was used for data collection. This researcher made questionnaire was used for the study, which its validity and reliability were determined before data gathering. Seven general areas were designed in the questionnaire: (1) Demographic data; (2) relationship between clients and service provider; (3) counseling conditions; (4) family planning; (5) genetic counseling; (6) thalassemia; and (7) sexual health. The client s viewpoint was assessed by 4 point Likert scale questions. All statistical analyses were performed using SPSS, version 13 (SPSS, Chicago, Illinois). Chi Square was used for categorical data. Furthermore, correlation of age with the quality of different areas in the 366 premarital counseling questionnaire was assessed by the Spearman correlation coefficient. All hypotheses tests were 2 tailed with P <0.05 considered to be significant. RESULTS The results of the present study on the demographic characteristics of the participants are showed in Table 1. The findings regarding the viewpoint of the women about the premarital counseling classes showed that 75.8% of the participants reported the service provider had a good relation with their clients [Table 2]. As shown in the Table 2, nearly 85.2% of women assessed the conditions and environment of counseling class as good while in the aspects of the quality of family planning area, 72.5% of them assessed it as relatively good. Regarding the topic of family planning and its importance, the result of Chi square test showed a significant relationship between the participants educational level and their viewpoint Table 1: Demographic characteristics of women attending in premarital counseling classes Variables Number (%) Age 21.11±4.13* Primary school 10 (4.2) Guidance school 27 (11.4) High school 113 (48.0) University degree 86 (36.4) Occupation Student 82 (34.7) Housewife 119 (50.5) Working at home 9 (3.8) Working outside the home 26 (11.0) Previous information Yes 121 (51.3) No 115 (48.7) Source of information Health care providers 16 (12.4) Radio/TV 15 (11.6) Inter human communication 32 (26.4) (family, friends, and acquaintances) Personal studies 42 (34.7) Other sources 16 (13.2) Current residency status Urban area 206 (87.3) Rural area 30 (12.7) *Mean±SD

3 about the related discussed area in the premarital classes (P = 0.001). Hence that, 24.3% of women with primary/guidance school degree versus 7.1% and 10.5% respectively in individuals with high school and university degree stated that the quality of this topic was poor in the classes [Table 3]. The majority of participants stated that among the contraceptive methods, the explanation on oral contraceptive pill and condom was relatively good (70.8% and 76.7%, respectively). Only 7.3% of women living in urban areas versus 26.7% of whom living in rural area stated the quality of counseling materials about condom as poor (P = 0.002) [Table 3]. However, for intrauterine device (IUD) and contraceptive injections, it was poor/completely poor in view of about half of women (46.7% and 53.0%, respectively). The result of Chi square test showed a significant Table 2: The quality of different areas in the premarital counseling questionnaire in viewpoint of participated women Areas in the premarital counseling Quality of context (%) questionnaire Good Relatively good Poor Completely poor Relationship between clients and service provider 179 (75.8) 57 (24.2) Counseling conditions 201 (85.2) 35 (14.8) Family planning 39 (16.5) 171 (72.5) 26 (11.0) Contraceptive methods OCP 38 (16.1) 167 (70.8) 31 (13.1) Condom 32 (13.6) 181 (76.7) 23 (9.7) IUD 19 (8.1) 104 (44.1) 57 (24.2) 51 (21.6) Contraceptive injections 14 (5.9) 96 (40.7) 65 (27.5) 59 (25.0) Genetic counseling 104 (44.1) 90 (38.1) 28 (11.9) Thalassemia 30 (12.7) 117 (49.6) 68 (28.8) 21 (8.9) Sexual health 98 (41.5) 126 (53.4) 12 (5.1) OCP=Oral contraceptive pill, IUD=Intrauterine device Table 3: The results of statistical tests for significant associations of women s demographic characteristics and their viewpoint about the quality of different areas in the premarital counseling questionnaire Areas in the premarital counseling questionnaire Demographic characteristics Good (%) Relatively good (%) Quality of context Poor (%) Completely poor (%) P value Family planning Primary/guidance school 7 (18.9) 21 (56.8) 9 (24.3) High school 26 (23) 79 (69.9) 8 (7.1) University degree 6 (7) 71 (82.6) 9 (10.5) Contraceptive methods Condom Current residency status Urban area 31 (15) 160 (77.7) 15 (7.3) Rural area 1 (3.3) 21 (70) 8 (26.7) IUD Age 20.47± ± ± ± * Primary/guidance school 1 (2.7) 23 (62.2) 9 ( (10.8) High school 14 (12.6) 49 (44.1) 20 (18) 28 (25.2) University degree 4 (4.8) 32 (38.6) 28 (33.7) 19 (22.9) Genetic counseling Previous information Yes 62 (55.4) 38 (33.9) 12 (10.7) No 42 (38.2) 52 (48.3) 16 (14.5) Thalassemia Age 21.27± ± ± ± * Sexual health Age 20.03± ± ±1.15 <0.001* *Spearman correlation coefficient. OCP=Oral contraceptive pill, IUD=Intrauterine device 367

4 relationship between the educational level and viewpoint about the topic of IUD (P = 0.015) and hence that, 56.6% of participants with university degree versus 35.1% and 43.2% respectively in women with primary/guidance school and high school, the self perception about quality of this topic was poor (or very poor). Furthermore, there was a significant negative correlation between the age and the quality in participants viewpoint about of IUD topic (r = 0.181, P = 0.005) [Table 3]. About 82.2% of women stated that the training programs about genetics were good/relatively good. There was a significant different between women and without previous information in the viewpoint about the genetic topics (P = 0.037). In total, 55.4% of women with previous data versus 38.2% of whom without any information stated the quality of this topic as good [Table 3]. While 62.3% of participants stated the topic about thalassemia as good/relatively good, it was poor/completely poor in 37.7% of them. Regarding the area of sexual health in the classes, over half of women (58.5%) reported that the topic was poor/completely poor. There was a negative correlation between the women s mean age and the score of their viewpoints about the quality of both thalassemia and sexual health areas (r = 0.128, P = and r = 0.226, P < 0.001, respectively). DISCUSSION The results of the present study showed that most of the women participated in our research reported the quality of aspects presented in the premarital counseling classes as moderate (relatively good). The most weakness was observed in the area of sexual health, thalassemia and some contraceptive methods including IUD and contraceptive injections. In a study carried out by Salarvand et al. in Iran (Gonabad), [4] moderate satisfaction levels with the quality of the premarital counseling classes was reported. Another study in Iran, by Pakgohar et al. demonstrated that the couples who had received regular counseling in health care centers assessed the quality of the classes as moderate. [5] In the later study, 68.6% of the subjects were dissatisfied with the quality of describing the way of using contraceptive methods. [5] Although, our finding reflect a better quality in terms of presenting contraceptive methods, the content of 368 training program for various methods, especially for IUD and injection, needs to be revised for more effective supports in related health issues. A study conducted in South and East Asia by Pachauri and Santhya indicated that an accurate and user friendly data on sexuality, reproduction and contraceptive is required for all adolescents. They recommended that the reproductive and sexual health training programs should be adopted for differences in social and cultural environments as well as the clients characteristics in each society. [6] Thus, researchers believe that premarital training programs and counseling classes are needed for all communities and its management is necessary, so that Garwick et al. and Fisher et al. in their study demonstrated that it have significant influences on the sexual behaviors. [7,8] CONCLUSIONS Our study results can provide suitable information for health policy providers to improve the quality of premarital counseling classes. The education for couples in health care centers and its tracing is a very important issue for decision makers. In order to develop a relatively stable behavior in young couples, it is recommended that the quality of the classes would be overemphasized. It seems necessary to allocated more time to these classes and to enrich educational content items for targeted groups. ACKNOWLEDGMENT The research was funded by Tabriz University of Medical Sciences. The funding source had no involvement in any aspect of the research. We acknowledge the help of the premarital counseling centers as well as the women who participated in the study. REFERENCES 1. Motamedi B, Ahmadi ZS, Nikian Y. Effect of premarriage counseling on girls knowledge. Feyz 2004;8: [Persian]. 2. Vakilian K, Mirzaii K, Najm Abadi. Reproductive health in Iran: International conference on population and development goals. Oman Med J 2011;26: Khaleghinejad K, Abbaspour Z, Afshari P, Attari Y, Rasekh A. Educational needs in premarital counseling: Viewpoints of couples referring to health care centers in Mashhad. Iran J Med Educ 2009;8:

5 4. Salarvand S, Binabaj NB, Pournia Y. Young clients satisfaction with the quality of premarital family planning counseling services. Middle East J Nurs 2012;6: Pakgohar M, Rahimikian F, Mehran A, Mohammadi T. Quality assessment of family planning counseling in health and treatment centers, affiliated to Tehran University of Medical Sciences. HAYAT 2002;8: [Persian]. 6. Pachauri S, Santhya KG. Reproductive choices for Asian adolescents: A focus on contraceptive behavior. Int Fam Plan Perspect 2002;28: Garwick A, Nerdahl P, Banken R, Muenzenberger Bretl L, Sieving R. Risk and protective factors for sexual risk taking among adolescents involved in Prime Time. J Pediatr Nurs 2004;19: Fisher JA, Bowman M, Thomas T. Issues for South Asian Indian patients surrounding sexuality, fertility, and childbirth in the US health care system. J Am Board Fam Pract 2003;16: Source of Support: The research was funded by Tabriz University of Medical Sciences, Conflict of Interest: None declared. New features on the journal s website Optimized content for mobile and hand-held devices HTML pages have been optimized of mobile and other hand-held devices (such as ipad, Kindle, ipod) for faster browsing speed. Click on [Mobile Full text] from Table of Contents page. This is simple HTML version for faster download on mobiles (if viewed on desktop, it will be automatically redirected to full HTML version) E-Pub for hand-held devices EPUB is an open e-book standard recommended by The International Digital Publishing Forum which is designed for reflowable content i.e. the text display can be optimized for a particular display device. Click on [EPub] from Table of Contents page. There are various e-pub readers such as for Windows: Digital Editions, OS X: Calibre/Bookworm, iphone/ipod Touch/iPad: Stanza, and Linux: Calibre/Bookworm. E-Book for desktop One can also see the entire issue as printed here in a flip book version on desktops. Links are available from Current Issue as well as Archives pages. Click on View as ebook 369